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Maria Celia B. Hughes, MMedSci; Gail M. Williams, PhD; Peter Baker, PhD; and Adèle C. Green, MBBS, PhD

Whether sunscreen or dietary supplements, such as β-carotene, protect against skin aging has not been established. In this randomized trial, participants assigned to daily application of sunscreen showed less skin aging after 4 years than those assigned to discretionary use. No difference in skin aging was shown with daily β-carotene supplementation compared with placebo, but these findings need confirmation before firm conclusions can be made.

Topics: skin aging, sunscreening agents, solar degeneration
  
Catherine M. DesRoches, DrPH; Anne-Marie Audet, MD; Michael Painter, MD; and Karen Donelan, ScD

The Centers for Medicare & Medicaid Services provides incentive payments to physicians who meet electronic health record (EHR) meaningful use criteria. Whether most physicians with EHRs are able to meet these criteria is unknown. Approximately 40% of physicians in this national survey reported using an EHR, but only 1 in 10 reported being able to use it to meet meaningful use criteria and half believed that it was difficult to meet at least some criteria. The authors conclude that EHR adoption does not necessarily ensure better patient management.

Topics: electronic medical records, health information technology
  
David R. Anderson, MD; Michael J. Dunbar, MD; Eric R. Bohm, MD; Etienne Belzile, MD; Susan R. Kahn, MD; David Zukor, MD; William Fisher, MD; Wade Gofton, MD; Peter Gross, MD; Stephane Pelet, MD; Mark Crowther, MD; Steven MacDonald, MD; Paul Kim, MD; Susan Pleasance, BScN; Nicki Davis, BSc; Pantelis Andreou, PhD; Philip Wells, MD; Michael Kovacs, MD; Marc A. Rodger, MD; Tim Ramsay, PhD; Marc Carrier, MD; and Pascal-Andre Vendittoli, MD

The role of aspirin in thromboprophylaxis after total hip arthroplasty (THA) is controversial. This trial randomly assigned THA patients to 28 days of aspirin or dalteparin after an initial 10 days of dalteparin and found that aspirin was noninferior for preventing venous thromboembolism and caused less bleeding. However, the trial was stopped early because of slow enrollment, so findings are based on very few events. These findings suggest that aspirin may be a reasonable alternative to low-molecular-weight heparin for extended thromboprophylaxis among THA patients after 10 days of low-molecular-weight heparin.

Topics: low-molecular-weight heparin, hip replacement arthroplasty, thromboprophylaxis, aspirin, venous thromboembolism, hemorrhage
  

This review examined evidence on the accuracy of blood tests to diagnose fibrosis in patients with chronic hepatitis C virus (HCV) infection. Evidence shows that platelet count, the age–platelet index, the aspartate aminotransferase–platelet ratio index (APRI), FibroIndex, FibroTest, and the Forns index are moderately useful for identifying fibrosis. Platelet count, the age–platelet index, APRI, and Hepascore were moderately useful for identifying cirrhosis. The findings suggest that blood tests can help to identify HCV-infected patients with clinically significant fibrosis, with somewhat greater accuracy for identifying cirrhosis than for less advanced fibrosis.

Topics: blood test, hepatitis c, chronic, liver cirrhosis, fibrosis, virus diseases
  
Ruth Etzioni, PhD; Roman Gulati, MS; Leslie Mallinger, MPH; and Jeanne Mandelblatt, MD, MPH

Estimates of the frequency of overdiagnosis in breast and prostate cancer screening vary greatly across studies. Investigators examined features of published studies that influence estimates of overdiagnosis, including overdiagnosis definition and measurement, contextual features, and estimation approach. Understanding how these features affect results will help policymakers, clinicians, and patients interpret estimates of cancer overdiagnosis.

Topics: overdiagnosis, prostate cancer screening, breast
  

This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of endocrinology. Topics include diabetes mellitus, thyroid disease, and osteoporosis.

Topics: osteoporosis, diabetes mellitus, type 2, fracture, endocrinology, vitamin d, zoledronic acid, glucose ...
  
Paul E. Stevens, MBBS, BSc; Adeera Levin, MD, BSc, for the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members*

The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving renal replacement therapy. This synopsis focuses on key recommendations from the guideline pertinent to identification, classification, monitoring, and management of CKD in adults.

Topics: kidney diseases, kidney failure, chronic, clinical practice guideline
  

In December 2012, the American College of Obstetricians and Gynecologists released a Committee Opinion supporting over-the-counter access to oral contraceptive pills. This commentary makes a case that over-the-counter provision of oral contraceptive pills is both safe and effective for reducing unintended pregnancies.

Topics: oral contraceptives, drugs, non-prescription, unplanned pregnancy
  
Hillary V. Kunins, MD, MPH, MS; Thomas A. Farley, MD, MPH; and Deborah Dowell, MD, MPH

In January 2013, the New York City Department of Health and Mental Hygiene released guidelines to help reduce the misuse of prescription opioid analgesics by establishing standards for prescribing from the emergency department. In this commentary, authors employed by the department discuss the recommendations and why they are likely to help emergency and other physicians provide safer care for patients with pain.

Topics: opioid analgesics
  

In January 2013, the New York City Department of Health and Mental Hygiene released guidelines to help reduce the misuse of prescription opioid analgesics by establishing standards for prescribing from the emergency department. In this commentary, the President-Elect of the American College of Emergency Physicians argues that restricting opioid prescription by emergency physicians will not solve the problem of opioid misuse. Rather, closing corrupt pain centers and improving access to high-quality nonemergency care will improve the care of patients with pain.

Topics: opioid analgesics
  

In this issue, DesRoches and colleagues examined physician use of EHR systems to manage their patient populations and their expectations of the influence of EHRs on health care outcomes and costs. The editorialist discusses the study and its findings and concludes that our focus must shift from EHR use to EHR utility.

Topics: health information technology, electronic medical records
  
A. M. Horowitz, MFA
Includes: Audio/Video

The road to becoming a physician is a grueling one. But in the end, doctors experience the reward of knowing they have healed someone or eased their pain. The family members of physicians share in many of the sacrifices the medical profession exacts on its doctors but never experience the satisfaction.

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Shadi Kalantarian, MD, MPH; and Jeremy N. Ruskin, MD
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Jason D. Eubanks, MD
Includes: Audio/Video
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Linda A. Jacobs, PhD, RN; and David J. Vaughn, MD
Includes: CME
Topics: cancer, cancer survivorship, survivors
  
Topics: skin aging, sunscreening agents
  
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